Engineering World Healthand

The Role of BME in Global Health

Robert MalkinDuke University

Engineering World Health

$29 billion

$31 billion

Global Health

What are they all talking about?What is Global Health?

What is global?

Dry, ice and green on earth

What is Global?

Earth at Night

What is Global?

Population Density

(Millions per square mile)

% Without safe water

What is Global Health?

What is Global Health?

% Stunting

What is Global Health?

% HIV Positive

What is Global Health?

Life Expectancy

What is Global Health?

UN Human Development Index Low Human Development (least, third)

High Human Development (most, first)

Medium Human Development

So, what can we

do?

Conclusion:Send $$

Least Most Developed Nations

Not so fast!

Not so fast!

Conclusion:Send Stuff

Just Sending $ Won’t Work

Savannah Carson, EWH volunteer with new friends in Tanzania

CorruptionBrain DrainInfrastructure

80% of hospital equipment in least developed nations

is donated

WHO Guidelines for Medical Equipment DonationsWHO Essential Health Care Technology: http://www.who.int/medical_devices/en/index.html

At the end of the day, this girl was waiting

My Experience at Kissy Eye ClinicFreetown,Sierra Leone

Arrival with cataract surgeon

Where Sierra Leone?

UN Human Development Index Low Human Development (least, third)

High Human Development (most, first)

Medium Human Development

Sierra Leone

Sierra Leone

• Life Expectancy - 38 years

• Safe Drinking Water - 54%

• Infant Mortality - 170/1000

• Under Five Mortality - 286/1000

Ingrid

BB

Adolfo

Cindy

Something Was Wrong•It was late at night•Cataract patients waiting•Phaco and XYZ = 20 minutes

Got to Work

•In 30 minutes•Fixed the XYZ•All Patients Treated

Training Paul to work on XYZ Scope

Needed •Spare parts•Tools•Knowledge

EWH Experiencewith donated medical equipment

• 62 Hospitals in 18 Countries – (almost all low HDI)

• 1710 Failure Analyses• 176 compliant long interviews• About 1500 short interviews• About 450 reported long interviews

Spare Parts

Training

Parts (29% power supply)*

Training/Installation (24% -

incl. user error)*

*Malkin, Annual Review of Biomedical Engineering, 2007

O2 sensorNeeds replacement

Tracy Lipps with donated Siemens VentilatorsWorked for 4 months, then stopped

Jinotepe, Nicaragua

Sidelined due to consumables

Needles

Electrodes

Sensors

Test strips

Reaction Cartridges

Blood Pressure Cuffs

Printing Paper

Sterilization Check strips

IV Pump Cartridges

Reagent Packs

Bovie Pens

Tubing

Canulae Consumables

70% of all donated medical equipment does not work*

Mostly due to **

•lack of spare parts

•consumables

•Training/installation

*WHO Guidelines for Medical Equipment Donations** Malkin, Annual Review of Biomedical Engineering, 2007

Malignant neoplasm, % of population

Wrong Stuff

Leading Causes of Mortality

WHO data 2003 (COPD= chronic obstructive pulmonary disease)

Most Developed Nations Least Developed Nations

Leading Causes of Morbidity(loss of quality of life - DALY)

5 Most Developed Nations % DALY loss

5 Least Developed Nations % DALY loss

1 Malignant neoplasms 16 1 Lower respiratory infections 142 Unipolar depressive disorders 9 2 Malaria 83 Ischaemic heart disease 7 3 HIV/AIDS 84 COPD 4 4 Diarrhoeal diseases 8

All Causes of MorbidityAll SignificantCauses of Morbidity 5 Most Developed Nations 5 Least Developed Nations

1 Lower respiratory infections 0.9 14.12 Malaria 0.0 8.43 HIV/AIDS 0.2 8.34 Diarrhoeal diseases 0.2 8.15 Birth asphyxia and birth trauma 0.4 3.66 Maternal conditions 0.4 3.57 Nutritional deficiencies 0.7 3.48 Perinatal Low birth weight 0.3 3.29 Other unintentional injuries 1.8 2.8

10 Measles 0.0 2.611 Road traffic accidents 1.9 2.212 Tuberculosis 0.0 2.0

13 Malignant neoplasms 15.9 1.014 Unipolar depressive disorders 9.2 0.915 Ischaemic heart disease 7.1 0.716 Chronic obstructive pulmonary disease 4.5 0.217 Cerebrovascular disease 4.3 0.818 Alzheimer and other dementias 4.1 0.119 Alcohol use disorders 4.0 0.120 Hearing loss, adult onset 3.6 0.421 Osteoarthritis 2.4 0.222 Diabetes mellitus 2.2 0.223 Self-inflicted injuries 2.1 0.2

Significant (>=2%)Insignificant (<=1%)

% of Total DALY's

What is Everyone Talking About?

• Global Health = not us– prototype = Africa

• Sending $$ is NOT the answer– Only medium human development

• Sending stuff is NOT the answer– Spare parts, training, consumable– wrong stuff

• There is no silver bullet

What is the answer?

Develop a lot of new stuff

Why should you care

$60 billion

Buffet and Gates know this too

What is Engineering World Health

doing?

EWH is

TN-based

Non profit

Delivering healthcare technology to those in need

Duke-EWHSummer Institute

50 Participants in 2008

1 Month Training in Costa Rica/Tanzania

1 Month in a poor HospitalNicaragua, Honduras, Tanzania, Kenya

Month Training: Intense Study• Daily Language • Daily Culture• Daily Lecture• Daily Lab• Additional

Training

Then The Trip Starts!

Duke-EWHSummer Institute

Analysis FailuresRepairing Equipment

29% Spare Parts for the Power Supply

InventoryWhat do they have?

Training24% training including user error and installation

Identifying Needs“The Long Interview”

Health Impact• 2003-2007: 1130 pieces placed into service• $2-$3 million worth

Trip Profile: Stephanie Patnode University of Southern California, UC Berkeley“I’d go back tomorrow. I … for once, felt like an engineer.”

TrainingGlobal Engineers

Special Features• Family Program (day care, family housing)• Open Internationally• 1-Year Experiences

– Engineering Volunteer - domestic – One-Year Internship - abroad

• Graduate Fellowships (MEM, MS)

Trip Profile Jody RiskowskiUniversity of WyomingIU-PUI

“When we arrived, a nurse produced three ‘broken’ ECG machines. This was in a ward where not one patient was being monitored. We quickly discovered that the machines worked, but hadn’t been set-up correctly. We set them up and before we left, we saw patients being properly monitored for the first time.”

“The summer was an amazing experience, and one I will never forget. I grew and changed. It was the best time of my life.”

CUREsA non-profit business program

Program takes advantage of three prominent institutions within Duke

Duke University

School of Medicine

CUREsNon-Profit Business Incubation

Duke Bus/Mgmt Students create

bootstrapped start-upsearned-incomenon-profit, healthcare technology

business plans

Examples:

BP Assist Device Project

Cervical Cancer Screening/Detection/Treatment

Bilirubin treatment device

End of Spring– Winner chosen $$$

Steps• Needs Finding• Business Plan• Engineering Prototyping• “Winning”• Redesign/Testing• Initial Clinical Trials (Duke)• Field Trials (40 units)• Redesign/Testing• Launch – first sales order

30,000 Children

Senior Design Projects that Matter

Design for the Developing World

• Web Site: www.ewh.org/youth• Lists about 20 Identified Needs• Anyone can design solutions

– EWH will pay for prototyping– Local manufacturability (new for

2006-2007)– May enter distribution system

Vanderbilt

Defibrillation Tester

High School, Middle School, Clubs, EWH Chaptersand individuals purchase parts and build equipment

High School in Nashville

Science Club In Memphis

Summer Camp in Durham

LA Tech

Kits comingsoon

Sudan

Nicaragua

• >1000 pieces delivered• >$1 Million (replacement value)

El Salvador

Philippines Indonesia

EWH Chapters

Cambridge University, England … and others

EWH Chapters

5 Core Activities

1) Repair Sessions2) Designing New Equipment3) Attending/Hosting Conferences4) Builds 5) Fellowship Raising

Summer Program: Fellowships, financial aid set-asides

EWH Chapters•Meet Weekly or Bi-Weekly•10-15 Students per meeting

Guidelines available from info@ewh.org

UNC/NC State/Duke EWH Chapters building phototherapy devices

Congressman Price, the Mayor of Durham, Chuck Messer

BME potential not fully realized

Spare Parts

Training programs

•BME, BMT

Information networks

•Manuals

•Tech support

Donation Guidance

•Testing, Consumables, Supplies

U. Houston EWH Chapter In MedicalBridge’s Warehouse

EWH: Succeeds Through Generous Support of our

Partners

Duke UniversityHamilton RoddisFOUNDATION

Gift of LifeLeonard M. Foundation

BME Has a Unique RoleYou must make that Role a Reality

www.ewh.org